Stomatitis

Stomatitis

Definition

Stomatitis is an inflammation of the mucous lining of the mouth, which may involve the cheeks, gums, tongue, lips, and roof or floor of the mouth. The word "stomatitis" literally means inflammation of the mouth.

Description

Stomatitis is an inflammation of the lining of any of the soft-tissue structures of the mouth. It is usually a painful condition, associated with redness, swelling, and occasional bleeding from the affected area. The inflammation may be caused by conditions in the mouth itself, such as poor hygiene, from burns from hot food or drinks, or by conditions that affect the entire body, such as medications, allergic reactions, or infections. Children may develop stomatitis at any point in their development, from infancy to adolescence . The two most common types seen in children are herpes stomatitis, which is caused by the herpes simplex virus, and aphthous stomatitis, more often referred to as canker sores .

Transmission

Depending upon its cause, stomatitis may or may not be contagious. Herpes stomatitis is considered contagious. Children may be exposed through kissing, sharing food, or playing in close contact with others who have an active herpes infection, such as a cold sore . Aphthous stomatitis is not contagious.

Demographics

Though stomatitis may occur at any time during a child's growth, different types affect children at different times. Herpes stomatitis can occur anywhere between six months and five years of age but is most common in children one to two years old who have not been exposed to the herpes virus before. Aphthous stomatitis begins in childhood or adolescence, with peak onset in those aged ten to 19 years. Aphthous ulcers may be more common in females than males. Children of higher socioeconomic status may be more affected than those who are from lower socioeconomic groups.

Causes and symptoms

Causes

A number of factors can cause stomatitis. Cheek biting, braces, or jagged teeth may persistently irritate the oral structures. Chronic mouth breathing due to plugged nasal airways may cause dryness of the mouth tissues, which in turn leads to irritation. The cause of herpes stomatitis is the herpes virus type 1 (not to be confused with genital herpes, which is caused by the herpes virus type 2 and is a sexually transmitted disease). The cause
of aphthous stomatitis is unknown, although several factors are suspected. There may be an inherited tendency to develop canker sores and there may also be an immune system link. In addition, they may be triggered by emotional stress; nutritional deficiencies of iron, folic acid , or vitamin B12; menstrual periods; food allergies ; or viral infections. They may occur with no identifiable cause.

Symptoms

Stomatitis is characterized by pain or discomfort in the mouth and the presence of open sores or ulcers in the mouth. Herpes stomatitis may cause the following symptoms:

fever , sometimes as high as 101–104°F (38.3–40°C), which may precede the appearance of blisters and ulcers by one or two days

irritability and restlessness

blisters in the mouth, often on the tongue or cheeks or roof of the mouth, which then pop and form ulcers (These ulcers are usually small [about one to five millimeters in diameter], grayish white in the middle, and red around the edges.)

swollen gums, which may be irritated and bleed

pain in the mouth

drooling

difficulty swallowing

foul-smelling breath

Aphthous stomatitis may cause the following symptoms:

burning or tingling sensation in the mouth prior to the onset of other symptoms

skin lesions on the mucous membranes of the mouth, which begin as a red spot or bump, then develop into an open ulcer, which is usually small (one to two millimeters to one centimeter in diameter) (The ulcers can be single or break out in clusters. The ulcers are painful, and the center appears white or yellow with a fibrous texture. The border of the sore may be bright red.)

When to call the doctor

Parents should call the doctor if any of the following occur:

inability to drink or swallow

high temperature

fussiness and inability to settle down

symptoms not improved after three days

If the child appears dehydrated, parents should seek immediate medical attention. Signs include dry lips, the absence of tears when crying, a sinking soft spot on an infant's head, and no urination in eight hours or very dark urine. Parents should also seek care if the child is very weak, tired, or difficult to waken.

Diagnosis

Stomatitis is diagnosed by the doctor based primarily upon the appearance of the mouth sores. Both herpes and aphthous stomatitis have lesions that are unique in appearance. Although laboratory studies are seldom performed, the physician may order further blood tests or cultures of the lesions in order to confirm the diagnosis and rule out other causes.

Treatment

The treatment of stomatitis is based upon the problem causing it. For all types, local cleansing and good oral hygiene is fundamental. Sharp-edged foods such as peanuts, tacos, and potato chips should be avoided. A soft-bristled toothbrush should be used, and the teeth and gums should be brushed carefully. If toothbrushing is too painful, the child should rinse out his mouth with plain water after each meal. Local factors, such as sharp teeth or braces, can be addressed by a dentist or orthodontist.

Herpes stomatitis treatment

In herpes stomatitis, the most important part of treatment is for parents to keep their child drinking as normally as possible. Bland fluids such as apple juice, liquid flavored gelatin, or lukewarm broth are easiest to drink. Sucking on a Popsicle or sherbet may be soothing. Citrus juices and spicy or salty foods should be avoided. In the event of severe disease, the doctor may use intravenous fluids to prevent dehydration . Acetaminophen may be used for temperatures over 101°F (38.3°C) and to address pain. Medicines that numb the mouth, like viscous lidocaine or topical anesthetics only last for a brief time and, by numbing the mouth, may cause your child to further injure damaged tissues without knowing it. Antibiotics are of no help in treating herpes stomatitis. However, if the case is particularly severe, the doctor may prescribe an antiviral medication such as acyclovir which, if given at the beginning of the outbreak, may help clear things up faster.

Aphthous stomatitis treatment

Medical treatment is usually not necessary for aphthous stomatitis, unless the ulcers are severe (larger
than one centimeter or lasting longer than two weeks). In this case medical evaluation and treatment may be indicated, and topical or oral tetracycline may be given. However, tetracycline is usually not prescribed for children until after all of their permanent teeth have erupted, as it can permanently discolor teeth that are still forming. Avoid hot or spicy foods to minimize discomfort. Mild mouth washes such as salt water or over-the-counter mouthwashes may help. Over-the-counter topical medications applied to the ulcerated area may reduce discomfort and sooth the area. To prevent bacterial infections from developing, parents should encourage their child to brush and floss teeth regularly.

Alternative treatment

Placing a spent tea bag on a canker sore may provide comfort. Sodium lauryl sulfate (SLS), a component of some toothpastes, is a potential cause of canker sores. In one study, most recurrent canker sores were eliminated just by avoiding SLS-containing toothpaste for three months.

Nutritional concerns

Some physicians may recommend a variety of dietary measures to treat stomatitis. These may include eating cottage cheese, buttermilk, and yogurt, as well as foods high in B vitamins . Some doctors may recommend supplementation with folic acid, iron, or vitamin B12.

Prognosis

The prognosis for the resolution of stomatitis is based upon the cause of the problem. Many mouth ulcers are benign and resolve without specific treatment. In the case of herpes stomatitis, complete recovery is expected within ten days without any medical intervention. Oral acyclovir may speed up recovery. Most children are minimally inconvenienced by aphthous stomatitis, because attacks are usually infrequent and only last a few days.

Prevention

Stomatitis caused by irritants can be prevented by good oral hygiene, regular dental checkups, and good dietary habits. Because so many adults and children carry the herpes virus, and because they can pass it on even if they have no symptoms, there is no practical way to prevent herpes stomatitis. Parents can, however, discourage their child from kissing, sharing food, or playing in close contact with people who have an active herpes infection.

Canker sores may be minimized by teaching children to avoid trauma, even minor trauma, to the mouth, such as hard toothbrushes and rough foods. If the doctor has determined that the child has a nutritional deficiency, parents can insure that the child is taking the appropriate supplements and eating the recommended foods. Avoiding stressful situations may also be beneficial.

Parental concerns

Most cases of stomatitis in children are benign and resolve within a relatively short period of time. Children with herpes stomatitis may return to school or day care when their fever is gone and the mouth sores are healed. Since aphthous stomatitis is not contagious, there is no need to curtail a child's activities unless they have developed signs of complications, such as infection.

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Stomatitis

Gale Encyclopedia of Medicine, 3rd ed.
COPYRIGHT 2006 Thomson Gale

Stomatitis

Definition

Inflammation of the mucous lining of any of the structures in the mouth, which may involve the cheeks, gums, tongue, lips, and roof or floor of the mouth. The word "stomatitis" literally means inflammation of the mouth. The inflammation can be caused by conditions in the mouth itself, such as poor oral hygiene, poorly fitted dentures, or from mouth burns from hot food or drinks, or by conditions that affect the entire body, such as medications, allergic reactions, or infections.

Description

Stomatitis is an inflammation of the lining of any of the soft-tissue structures of the mouth. Stomatitis is usually a painful condition, associated with redness, swelling, and occasional bleeding from the affected area. Bad breath (halitosis) may also accompany the condition. Stomatitis affects all age groups, from the infant to the elderly.

Causes and symptoms

A number of factors can cause stomatitis; it is a fairly common problem in the general adult population in North America. Poorly fitted oral appliances, cheek biting, or jagged teeth can persistently irritate the oral structures. Chronic mouth breathing due to plugged nasal airways can cause dryness of the mouth tissues, which in turn leads to irritation. Drinking beverages that are too hot can burn the mouth, leading to irritation and pain. Diseases, such as herpetic infections (the common cold sore), gonorrhea, measles, leukemia, AIDS, and lack of vitamin C can present with oral signs. Other systemic diseases associated with stomatitis include inflammatory bowel disease (IBD) and Behçet's syndrome, an inflammatory multisystem disorder of unknown cause.

Aphthous stomatitis, also known as recurrent aphthous ulcers (RAU) or canker sores, is a specific type of stomatitis that presents with shallow, painful ulcers that are usually located on the lips, cheeks, gums, or roof or floor of the mouth. These ulcers can range from pinpoint size to up to 1 in (2.5 cm) or more in diameter. Though the causes of canker sores are unknown, nutritional deficiencies, especially of vitamin B12, folate, or iron is suspected. Generalized or contact stomatitis can result from excessive use of alcohol, spices, hot food, or tobacco products. Sensitivity to mouthwashes, toothpastes, and lipstick can irritate the lining of the mouth. Exposure to heavy metals, such as mercury, lead, or bismuth can cause stomatitis. Thrush, a fungal infection, is a type of stomatitis.

Diagnosis

Diagnosis of stomatitis can be difficult. A patient's history may disclose a dietary deficiency, a systemic disease, or contact with materials causing an allergic reaction. A physical examination is done to evaluate the oral lesions and other skin problems. Blood tests may be done to determine if any infection is present. Scrapings of the lining of the mouth may be sent to the laboratory for microscopic evaluation, or cultures of the mouth may be done to determine if an infectious agent may be the cause of the problem.

Treatment

The treatment of stomatitis is based on the problem causing it. Local cleansing and good oral hygiene are fundamental. Sharp-edged foods such as peanuts, tacos, and potato chips should be avoided. A soft-bristled toothbrush should be used, and the teeth and gums should be brushed carefully; the patient should avoid banging the toothbrush into the gums. Local factors, such as ill-fitting dental appliances or sharp teeth, can be corrected by a dentist. An infectious cause can usually be treated with medication. Systemic problems, such as AIDS, leukemia, and anemia are treated by the appropriate medical specialist. Minor mouth burns from hot beverages or hot foods will usually resolve on their own in a week or so. Chronic problems with aphthous stomatitis are treated by first correcting any vitamin B12, iron, or folate deficiencies. If those therapies are unsuccessful, medication can be prescribed which can be applied to each aphthous ulcer with a cotton-tipped applicator. This therapy is successful with a limited number of patients. More recently, low-power treatment with a carbon dioxide laser has been found to relieve the discomfort of recurrent aphthae. Major outbreaks of aphthous stomatitis can be treated with tetracycline antibiotics or corticosteroids. Valacyclovir has been shown to be effective in treating stomatitis caused by herpesviruses.

Patients may also be given topical anesthetics (usually a 2% lidocaine gel) to relieve pain and a protective paste (Orabase) or a coating agent like Kaopectate to protect eroded areas from further irritation from dentures, braces, or teeth.

Alternative treatment

Alternate treatment of stomatitis mainly involves prevention of the problem. Patients with such dental appliances as dentures should visit their dentist on a regular basis. Patients with systemic diseases or chronic medical problems need to ask their health care provider what types of oral problems they can expect from their particular disease. These patients must also contact their medical clinic at the first sign of problems. Common sense needs to be exercised when consuming hot foods or drinks. Use of tobacco products should be discouraged. Alcohol should be used in moderation. Mouthwashes and toothpastes known to the patient to cause problems should be avoided.

Botanical medicine can assist in resolving stomatitis. One herb, calendula (Calendula officinalis ), in tincture form (an alcohol-based herbal extract) and diluted for a mouth rinse, can be quite effective in treating aphthous stomatitis and other manifestations of stomatitis.

More recently, a group of researchers in Brazil have reported that an extract made from the leaves of Trichilia glabra, a plant found in South America, is effective in killing several viruses that cause stomatitis.

Prognosis

The prognosis for the resolution of stomatitis is based on the cause of the problem. Many local factors can be modified, treated, or avoided. Infectious causes of stomatitis can usually be managed with medication, or, if the problem is being caused by a certain drug, by changing the offending agent.

Prevention

Stomatitis caused by local irritants can be prevented by good oral hygiene, regular dental checkups, and good dietary habits. Problems with stomatitis caused by systemic disease can be minimized by good oral hygiene and closely following the medical therapy prescribed by the patient's health care provider.

Resources

BOOKS

Beers, Mark H., MD, and Robert Berkow, MD., editors. "Disorders of the Oral Region." In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2004.

Shulman, J. D., M. M. Beach, and F. Rivera-Hidalgo. "The Prevalence of Oral Mucosal Lesions in U.S. Adults: Data from the Third National Health and Nutrition Examination Survey, 1988–1994." Journal of the American Dental Association 135 (September 2004): 1279-1286.

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Stomatitis

Gale Encyclopedia of Cancer
COPYRIGHT 2002 The Gale Group Inc.

Stomatitis

Description

Stomatitis describes an inflammation of the mucous membranes of the mouth. This condition, frequently referred to as mucositis , can result from cancer treatments such as chemotherapy and radiation therapy . It is characterized by mouth ulcers or sores, and pain in the mouth. The first symptoms may be sensitivity to spicy foods and reddened mucous membranes. The patient with stomatitis may also experience a dry or swollen tongue, difficulty swallowing, and an inability to eat or drink. It is usually a short-term condition, lasting from just a few days to a few weeks. Reddened areas in the mouth may appear as early as three days after receiving chemotherapy, but normally it is within five to seven days. As time goes on, ulceration occurs. The inflammation can range from mild to severe. If complications such as infection do not occur, stomatitis usually heals completely within two to four weeks.

Causes

Stomatitis is most often caused by cancer treatments such as chemotherapy and radiation therapy. Chemotherapy medications work because they are attracted to rapidly growing cells like cancer cells. However, many of the body's normal cells also grow rapidly, and chemo-therapy kills them as well. The mouth includes several structures that together are referred to as the oral cavity: the lips, teeth, gums, tongue, pharynx, and the salivary glands. Most of these structures are covered by mucous membranes, the shiny, pink moist lining of the mouth. The outer layer of mucous membranes grows very rapidly,
and because of this they can easily be damaged by chemotherapy and radiation therapy. When these cells are damaged, they slough off, and the lining of the mouth is left vulnerable and without protection. This exposed lining may become inflamed, swollen, and dry, and will often develop ulcers or sores.

Stomatitis caused by radiation therapy normally develops in the area where the radiation is given. It generally begins seven to fourteen days after starting radiation. It will usually exhibit improvement about two to three weeks after the treatment stops.

Stomatitis may also develop as an indirect result of cancer treatment or the cancer itself. Chemotherapy can frequently cause the patient's infection-fighting white blood cells to drop down below normal levels. When this happens, the body may be unable to keep the normal organisms in the oral cavity in balance and stomatitis, as well as infections, may result. The severity of the stomatitis is dependent on various factors, including the diagnosis, the patient's age, the patient's oral condition before cancer treatment, and the level of oral care during therapy. The duration and severity of the low white blood count is another factor.

Treatments

Various measures can be taken by the cancer patient to help prevent the occurrence or severity of stomatitis. A carefully followed program of good oral care started before cancer treatment can reduce the severity of stomatitis. The primary preventative measures include good nutritional intake, good oral hygiene practices, and early detection of any oral lesions by either the patient or a health care professional.

Once cancer treatment has started, the patient should carefully observe the mouth daily. The patient should
inform their health care professional if any symptoms such as reddened areas, swelling, blisters, sores, white patches, or bleeding are noted. Meticulous oral hygiene and comfort measures are the focus of care. Sometimes, no matter what the patient does, stomatitis occurs. However, if good oral care is performed, the severity of symptoms is usually lessened. The following measures may be recommended to treat stomatitis:

Rinsing the oral cavity after meals and before bedtime with a mild salt-water or baking soda and water solution will help keep the mouth clean and free of debris.

A soft-bristled toothbrush or soft foam tooth-cleaning device should be used to keep the mouth and teeth very clean.

Maintaining a good nutritional intake and drinking adequate amounts of fluids helps the body heal the stomatitis.

The use of any tobacco products and alcohol should be avoided, as they can irritate the lining of the mouth.

Avoid spicy or acidic foods, or very hot foods.

Sometimes stomatitis develops, no matter what the patient does. If the mouth sores are painful enough to prohibit eating and drinking, pain medications, including numbing medicines and both non-narcotic and narcotic pain medicines, may be prescribed.

Alternative and complementary therapies

Some preliminary studies have shown glutamine, an amino acid, to be effective in shortening the duration of stomatitis. Topical Vitamin E has also been studied and it shows some suggestions of being an effective therapy in patients with stomatitis. Other small studies suggest that using ice chips or a chamomile mouthwash will decrease the severity of symptoms. However, most of these studies have been small in scope, and cannot definitively claim the effectiveness of the varying treatments. As with anyone undergoing cancer treatment, the patient with stomatitis should consult with their physician or other health care professional regarding the usage of these alternative approaches.

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